Neurology exam Flashcards
Causes of Horner’s syndrome
Carcinoma of lung apex- squamous cell Thyroid malignancy, trauma Carotid aneurysm/dissection Brainstem lesion- vascular disease, tumour Retro-orbital lesion Syringomyelia
One-and-a-half syndrome
Horizontal gaze palsy when looking to 1 side
Impaired adduction on looking to other side
Exotropia (turning out) of eye opposite side of lesion
Causes- stroke, plaque of MS, tumour in dorsal pons
When combined with lesion of ipsilateral facial nerve causing LMN weakness –> eight-and-a-half syndrome
If suspecting Horner’s syndrome (partial ptosis + miosis)
- Test for anhydrosis
- Exclude lateral medullary syndrome - nystagmus, ipsilateral CN V, IX and X, ipsilateral cerebellar signs, contralateral pain and temp loss over trunk/limbs
- Check for hoarse voice, clubbing and finger abduction for C8/T1 lesion
- -> perform respiratory exam if signs present - Examine neck for lymphadenopathy, thyroid carcinoma, carotid aneurysm/bruit
- Check for dissociated sensory loss for syringomyelia
Causes of anosmia (CN I)
Bilateral- URTI, meningioma of olfactory groove, ethmoid tumours, head trauma, meningitis, hydrocephalus, Kallmann’s syndrome, COVID
Unilateral- meningioma of olfactory groove, head trauma
Light reflex
Via optic nerve and tract (no cortical involvement)
Accommodation reflex
Originates in cortex, associated with convergence
Relayed via parasympathetic fibres in CN III
Causes of absent light reflex but intact accommodation reflex
Midbrain lesion- Argyll Robertson pupil
Ciliary ganglion lesion- Adie’s pupil
Parinaud’s syndrome
Bilateral anterior visual pathway lesion
Causes of absent convergence but intact light reflex
Cortical lesion
Midbrain lesion
Causes of pupil constriction
Horner's syndrome Argyll Robertson pupil Pontine lesion Narcotics Pilocarpine drops Old age
Causes of pupil dilatation
Mydriatics, atropine poisoning, cocaine 3rd nerve lesion Adie's pupil Iridectomy, iritis Post-trauma Cerebral death Congenital
Tunnel vision
Glaucoma
Papilloedema
Enlarged blind spot
Optic nerve head enlargement
Central scotomata
Optic nerve head to chiasmal lesion- demyelination, toxic, vascular
Unilateral field loss
Optic nerve lesion- vascular, tumour
Retinal vein occlusion
Bitemporal hemianopia
Optic chiasma lesion- pituitary tumour, sella meningioma
Homonymous hemianopia
Optic tract to occipital cortex
Upper quadrant (superior) homonymous hemianopia
Temporal lobe lesion (PITS)
Lower quadrant (inferior) homonymous hemianopia
Parietal lobe lesion (PITS)
Adie’s syndrome
Lesion in efferent parasympathetic pathway
- Dilated pupil
- Decreased/absent reaction to light (direct and consensual)
- Slow/incomplete reaction to accommodation
- Decreased tendon reflexes
Typically young women
Argyll Robertson pupil
Lesion of iridodilator fibres in midbrain
Causes- syphilis, DM, alcoholic midbrain degeneration
Features- small irregular pupil, no reaction to light, prompt reaction to accommodation, decreased reflexes (if associated with tabes)
Papilloedema
Optic disc swollen without venous pulsation Normal early acuity and colour vision Large blind spot Peripheral constriction of visual fields Usually bilateral
Causes- space-occupying lesion, hydrocephalus, idiopathic intracranial HTN, HTN grave IV, central retinal vein thrombosis, cerebral venous sinus thrombosis, high CSF protein level (GBS)
Causes of optic atrophy
Chronic papilloedema or optic neuritis Optic nerve pressure/division Glaucoma Ischaemia Familial- Friedreich's ataxia, retinitis pigmentosa
Causes of optic neuropathy
MS Toxic- ethambutol, chloroquine, nicotine, alcohol Metabolic- vitamin B12 deficiency Ischaemia- DM, atheroma Familial- Leber's disease Infectious mononucleosis
Causes of cataract
Old age Endocrine- DM, steroids Hereditary- myotonic dystrophy Glaucoma Irradiation Trauma
Causes of ptosis
Normal pupils- senile ptosis, myotonic dystrophy, facioscapulohumeral dystrophy, ocular myopathy, thyrotoxic myopathy, myasthenia gravis, botulism, congenital, fatigue
Constricted pupils- Horner’s syndrome, tabes dorsalis
Dilated pupils- 3rd nerve lesion
3rd nerve palsy
Dilated pupil unreactive to light or accommodation
Complete ptosis
Divergent strabismus- ‘down and out’
Causes- central (vascular, tumour, demyelination, trauma), peripheral (compressive lesion eg. PICA aneurysm, infarction, cavernous sinus lesion)
CN III (oculomotor nerve)
Supplies superior rectus, inferior rectus, inferior oblique, medial recurs
CN IV (trochlear nerve)
Supplies superior oblique muscle –> intorts eye
6th nerve palsy
Failure of lateral movement- eye is deviated inwards (esotropia) if severe
Horizontal diplopia to affected side
Causes
- Bilateral = trauma, Wernicke’s encephalopathy, raised ICP, mononeuritis multiplex
- Unilateral = vascular, tumour (cavernous sinus, retro orbital), demyelination, diabetes, vasculitis/GCA, trauma, idiopathic, raised ICP, paraneoplastic, myasthenia gravis
Causes of nystagmus
Jerky
- Horizontal = vestibular lesion (away from lesion side), cerebellar (towards lesion side), INO (abducting eye)
- Vertical = brainstem lesion (upbeat = lesion in floor of 4th ventricle vs. downbeat = foramen magnum lesion), toxic (phenytoin, alcohol)
Pendular - retinal, congenital
Supranuclear palsy
Loss of vertical upward/downward gaze
- affects both eyes
- no diplopia
- reflex eye movements intact
- pupils often unequal
Parinaud’s syndrome
Loss of vertical upward gaze
Causes
- Central = pinealoma, MS, vascular lesions
- Peripheral = trauma, DM, idiopathic, raised ICP
CN V (trigeminal) palsy
Causes
- Central = vascular, tumour, syringobulbia, MS
- Peripheral = aneurysm, tumour (acoustic neuroma), chronic meningitis
- Cavernous sinus aneurysm, thrombosis, tumour
- Other = Sjogren’s, SLE, toxins
CN VII (facial) nerve palsy
UMN- contralateral weakness, spares frontalis muscle –> vascular, tumour
LMN- ipsilateral facial weakness of all muscles –> pontine stroke, posterior fossa tumour, Ramsay Hunt, Bell’s palsy, parotid (tumour, sarcoid)
Bilateral = GBS, bilateral parotid disease
Causes of sensorineural deafness
Degeneration Trauma Toxic- aspirin, alcohol Infection Tumour- acoustic neuroma Brain stem lesion
Causes of conductive hearing loss
Wax
Otitis media
Otosclerosis
Paget’s disease of bone
CN IX (glossopharyngeal) + X (vagus) palsy
Central = vascular (lateral medullary infarction), tumour, syringobulbia, MND Peripheral = aneurysm, tumour, chronic meningitis, GBS
CN XII (hypoglossal) palsy
UMN = vascular, MND, tumour, MS LMN = vascular, MND, syringobulbia, aneurysm, tumour, trauma
Causes of multiple cranial nerve palsies
Cavernous sinus lesion
Retroorbital lesion
Paraneoplastic
Nasopharyngeal carcinoma
Chronic meningitis
GBS
Brain stem lesions
Arnold-Chiari malformation
Trauma
Myopathies, NM disease
~~~
Dominant parietal lobe evaluation
Acalculia- mental arithmetic
Agraphia- inability to write
Left-right dissociation- put right hand onto left ear
Finger agnosia- inability to name individual fingers
Non-dominant parietal dysfunction
Dressing apraxia
Fluent aphasia
Receptive, conductive or nominal (Wernicke’s) = temporal gyrus in dominant lobe
- Unaware of aphasia
- Naming objects done poorly
- Difficulty repeating words
- Impaired comprehension in receptive
- Difficulty reading in conductive and receptive
- Impaired writing in conductive (dysgraphia) vs. abnormal content (receptive)
Non-fluent aphasia
Expressive (Broca’s) = frontal lobe
- Aware of aphasia –> frustrated
- Poor naming of objects
- Impaired repetition
- Normal comprehension
- Dysgraphia can be present
- Hemiparesis (arm > leg)
Dysarthria
Disorder of articulation with no disorder of content of speech
- consider cerebellar or lower cranial nerve lesion
- in cerebellar –> slurred, scanning (irregular, staccato)
- in pseudobulbar palsy –> slow, hesitant, hollow-sounding speech with harsh strained voice
Causes of pronator drift
Downwards- UMN weakness (due to muscle weakness)
Upwards- cerebellar lesion (due to hypotonia)
Any direction- posterior column loss (loss of joint position sense)
Muscle power grading
0- complete paralysis
1- flicker of contraction
2- movement with no gravity
3- movement against gravity only
4- movement against gravity with some resistance
5- normal power
LMN lesion
Weakness
Wasting
Decreased/absent reflexes
Fasciculation
UMN lesion
Spasticity
Clonus
Increased reflexes, extensor plantar response
Weakness more marked in UL abductor/extensor muscles and LL flexor muscles
Causes of peripheral neuropathy
Axonal (length dependent 75%)- diabetes, compression, alcohol, uraemia, heavy metal toxicity, Vit B12 deficiency, paraneoplastic
Demyelination (20%)- GBS/CIDP, metabolic (leukodystrophies), medications (amiodarone, TNF-antagonists, tacrolimus), infection, hereditary (CMT)
Cell body death (5%)- idiopathic, Sjogren’s, paraneoplastic, drugs (cisplatin, doxorubicin), Fabry’s
Causes of motor neuropathy
CIDP
MND- LMN variant
Hereditary motor and sensory neuropathy- Charcot Marie Tooth
Acute intermittent porphyria
DM
Lead poisoning
Multifocal motor neuropathy
Causes of sensory neuropathy
Diabetes
Carcinoma/paraneoplastic
AIDP
Vasculitic neuropathy
Vitamin B6 intoxication, Vit B12 deficiency
Sjogren’s syndrome
Syphilis
Causes of painful peripheral neuropathy
DM
Alcohol
Vitamin B12/B1 deficiency
Carcinoma
Porphyria
Arsenic/thallium poisoning
Nerve conduction findings for demyelinating disease
Velocity <75%
Distal latency >130%
Normal amplitude
Nerve conduction findings for axonal disease
Amplitude <50%
Velocity >70%
Causes of mononeuritis multiplex
Separate involvement of >1 peripheral nerve
Acute- diabetes, PAN, SLE, RA
Chronic- joint-deforming arthritis, sarcoidosis, acromegaly, leprosy, carcinoma, idiopathic
Causes of thickened nerves
Hereditary motor and sensory neuropathy Acromegaly CIDP Amyloidosis Leprosy
Causes of fasciculation
MND
Benign idiopathic fasciculation
Motor root compression
Malignant neuropathy
Spinal muscular atrophy
Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy)
Autosomal dominant
Features- pes cavus (short high-arched feet with hammer toes), distal muscle atrophy, absent reflexes, sensory loss in limbs, thickened nerves, optic atrophy, Argyll Robertson pupils
Complete lesion of brachial plexus
LMN signs affecting whole arm
Sensory loss
Horner’s syndrome (if proximal lesion in lower plexus)
Upper trunk lesion (Erb palsy)
C5-6
Loss of shoulder movement and elbow flexion
Hand in ‘waiter’s tip’ position
Sensory loss over lateral aspect of arm and forearm, over thumb
Lower trunk lesion (Klumpke palsy)
C8-T1
Claw hand with paralysis of all intrinsic muscles
Sensory loss along ulnar side of hand and forearm
Horner’s syndrome
Cervical rib syndrome
Weakness and wasting of small muscles of hand- claw hand
Sensory loss over medial aspect of hand and forearm
Unequal radial pulses and BP
Subclavian bruit and loss of pulse on arm manoeuvring
Palpable cervical rib in neck
Radial nerve lesion
C5-C8
Wrist and finger drop
Loss of elbow extension (if above spiral groove)
Sensory loss over anatomical snuff box and dorsal radial 3.5 digits
Median nerve lesion
C6-T1
Hand of benediction- unable to make fist
Weakness of thumb opposition, abduction and flexion
Wasting of thenar eminence
Loss of sensation of lateral 3.5 digits on palmar aspect
Tinel’s/Phalen’s positive
Causes of carpal tunnel syndrome
Idiopathic Pregnancy Endocrine disease- hypothyroidism, acromegaly Arthropathy- RA Trauma/overuse
Ulnar nerve lesion
C8-T1
Claw hand- unable to open fist
Wasting of hypothenar eminence
Weak finger abduction and adduction, wrist flexion
Froment’s sign- unable to grasp paper between thumb and forefinger
Sensory loss over medial 1.5 digits (dorsal and palmar aspects)
Femoral nerve lesion
L2-4 Weakness of knee extension Slight hip flexion weakness Preserved adductor strength Loss of knee jerk Sensory loss involving inner aspect of thigh and leg
Sciatic nerve lesion
Weakness of knee flexion
Loss of power of all muscles below knee causing foot drop (cannot stand on toes or heels)
Knee jerk intact
Loss of ankle jerk and plantar response
Sensory loss along posterior thigh and total loss below knee
Common peroneal nerve lesion
L4-S1
Foot drop, loss of foot eversion
Ankle reflex present
Sensory loss over dorsum of foot
Causes of foot drop
Common peroneal nerve palsy
Sciatic nerve palsy
Lumbosacral plexus lesion
L4/5 nerve root lesion
Peripheral motor neuropathy
Distal myopathy
MND
Precentral gyrus lesion
Spinal cord compression changes
LMN signs at level of lesion
UMN signs below lesion
Subacute combined degeneration of cord
Vitamin B12 deficiency
- symmetrical posterior column loss –> ataxic gait
- symmetrical UMN signs in LL with absent ankle reflexes, exaggerated/absent knee jerk
- peripheral sensory neuropathy
- optic atrophy
- dementia
Causes of extensor plantar response + absent ankle jerk
Subacute combined degeneration of cord Conus medullaris lesion Combination of UMN lesion with cauda equina compression/peripheral neuropathy Syphilis Friedreich's ataxia DM Adrenoleukodystrophy
Brown-Sequard syndrome
Motor- UMN signs below hemisection on ipsilateral side, LMN signs at level of hemisection on ipsilateral side
Sensory- pain and temperature loss on contralateral side, vibration + proprioception loss on ipsilateral side
Causes- MS, angioma, glioma, trauma, myelitis, post-radiation myelopathy
Causes of spinothalamic loss (pain and temperature)
Syringomyelia Brown-Sequard syndrome Anterior spinal artery thrombosis Lateral medullary syndrome Peripheral neuropathy
Cause of dorsal column loss (vibration + proprioception)
Subacute combined degeneration Brown-Sequard Spinocerebellar degeneration MS Tabes dorsalis Sensory neuropathy Peripheral neuropathy
Syringomyelia
Loss of pain + temperature over neck, shoulder, arms (cape like)
Amyotrophy of arms- weakness, atrophy, areflexia
UMN signs in LL
Causes of proximal muscle weakness
Myopathy
Neuromuscular junction disorder- MG
Neurogenic- Kugelberg-Welander disease, MND
Causes of myopathy
Inflammatory- polymyositis/dermato, inclusion body myositis, vasculitis
Endocrine- Cushing’s, thyroid
Metabolic- lipid/glycogen disorder, mitochondrial disorder, rhabdo
Infection- viral (HIV, hepatitis, EBV, influenza)
Toxic- EtoH, cocaine, medications (steroids, statins, fibrates, antimalarials)
Congenital dystrophies- Duchenne’s/Beckers, myotonic, FSH, limb girdle
Causes of proximal myopathy + peripheral neuropathy
Paraneoplastic syndrome
Alcohol
Connective tissue disease
Duchenne’s muscular dystrophy
Affects only males
Calves and deltoids are hypertrophied early, weak later
Early proximal weakness
Tendon reflexes preserved in proportion to muscle strength
Severe progressive kyphoscoliosis
Heart disease- dilated CM
CK markedly elevated
Becker’s = similar but later onset, less severe
Limb girdle muscular dystrophy
Shoulder/pelvic girdle affected
Onset in 3rd decade
Face and heart usually spared
Tests for myopathy
CK EMG ECG- for Duchennes, myotonic dystrophy Muscle biopsy Echocardiogram
Types of gait
Hemiplegic- foot plantarflexed and leg swung in lateral arc, unilateral, flexed elbow, extended knee/hip
Paraparetic- scissor gait e.g.cerebral palsy
Parkinsonian- stooped position, head down, festination, freezing, shuffling, reduced arm swing, slow turn
Cerebellar- wide-based gait, drunken appearance
Posterior column lesion/sensory- slapping of feet on broad base, positive Romberg’s
Distal weakness/neuropathic- high stepping gait, drop foot, can be bilateral
Proximal weakness/myopathic- waddling gait, positive Trendelenburg
Friedreich’s ataxia
Young person with
- cerebellar signs bilaterally
- posterior column loss in limbs
- UMN signs in limbs
- peripheral neuropathy
- optic atrophy
- pes cavus
- cardiomyopathy
- DM
Causes of spastic and ataxia paraparesis
UMN + cerebellar signs combined
- Spinocerebellar degeneration
- MS
- Spinocerebellar ataxia
- Arnold-Chiari malformation
- Syringomyelia
- Infarction
Causes of Parkinson’s
Idiopathic Drugs- methyldopa Post-encephalitis Toxins Wilson's disease
Types of tremor
Parkinsonian- resting, asymmetric
Essential- rapid, accentuated by stress, bilateral and symmetric, affects head/speech
- Causes- meds (amiodarone, steroids, lithium, thyroxine), toxins
Intention (cerebellar)- increases towards target
Cerebellar outflow tract tremor (red nucleus)- abduction-adduction movements of upper limbs with flexion-extension of wrists e.g. MS, brain injury
Causes of chorea
Huntington's disease Sydenham's chorea Senility Wilson's disease Drugs- OCP, phenytoin Vasculitis Thyrotoxicosis Polycythaemia
Wasting to abductor pollicis brevis (APB)
Median nerve lesion
Wasting to abductor digiti minimi and 1st dorsal interossei
Ulnar nerve lesion
Wasting of 1 hand and weakness of finger extensors/flexors + triceps
C7, C8, T1 root or plexus lesion
Investigations to request for MND
EMG –> evidence of denervation (fasciculations, fibrillation potentials)
NCS –> exclude multifocal motor neuropathy with conduction block
MRI of brain and spinal cord –> should be normal
Modified barium swallow –> check for aspiration
PFTs
Hereditary spastic paraparesis
Length-dependent degeneration of corticospinal tract in thoracic spinal cord + dorsal column Spastic gait- stiff, feet turned in UMN signs in LL Bilateral LL weakness Dorsal column impairment Bladder dysfunction Romberg's positive
Guillain-Barre syndrome
Bilateral symmetric weakness- likely ascending
Absent reflexes
Can affect ocular muscles
Paraesthesias in feet and hands
LP- albuminocytologic dissociation (high protein, normal WCC)
Myasthenia gravis
Fatiguable weakness Ptosis Diplopia worse on sustained gaze Weakness of facial muscles Myasthenic snarl Dysarthria Bovine cough Weakness of tongue Proximal limb girdle weakness Single fibre EMG- abnormal jitter Repetitive nerve stimulation- decreased response to stimuli
Midline cerebellar lesion signs
Affects vermis Romberg's positive Wide-based gait Truncal ataxia LL dysmetria (abnormal heel shin test) Horizontal gaze-evoked nystagmus (towards side of lesion) Saccadic intrusions Vertigo
Hemispheric cerebellar lesion signs
Dysdiadochokinesis UL/LL dysmetria (past pointing) Limb ataxia Intention tremor Ataxic dysarthria (alternating loudness, fluctuating pitch)
Cervical myelopathy signs
LMN signs at level of lesion UMN signs in LL Sensory changes No fasciculations Check neck for surgical scar
Anatomy of LMN
Anterior horn cell –> nerve root/nerve –> plexus –> peripheral nerve –> NMJ –> muscle
MND signs
Presence of UMN + LMN signs Asymmetric limb weakness Split hand syndrome- lateral aspect more wasted compared to medial Dysarthria Dysphagia Pseudobulbar palsy Fasciculations
Pseudobulbar palsy
Syndrome of bilateral UMN lesions of CN IX, X and XII
Causes- bilateral CVAs in internal capsule, MS, MND, high brainstem tumours, head injury
Increased/normal gag reflex
Spastic tongue
Increased jaw jerk
Slow, hesitant, hollow-sounding speech with harsh strained voice “Donald duck”
Bulbar palsy
LMN lesion of CN IX, X and XII
Causes- MND, syringobulbia, GBS, brainstem CVA, subacute meningitis
Absent gag reflex
Wasted tongue with fasciculations
Absent/normal jaw jerk
Nasal speech with imprecise articulation
Cerebellar speech
Slurred, staccato quality
If foot drop present, test for inversion/eversion
Inversion normal in common peroneal nerve
Inversion absent in L5 radiculopathy
Eversion lost in both
If foot drop present, test ankle jerk
If absent –> S1 lesion
If present –> common peroneal nerve lesion
If increased –> UMN cause or MND
Unilateral cerebellar disease causes
Space occupying lesion- tumour, abscess Ischaemia Paraneoplastic syndrome MS Trauma
Bilateral cerebellar disease causes
Drugs- phenytoin Friedreich's ataxia Hypothyroidism Paraneoplastic syndrome MS Trauma Alcohol Large space occupying lesion, cerebrovascular disease
Causes of pes cavus
Longstanding peripheral neuropathy
- Friedreich’s ataxia/spinocerebellar degeneration
- Hereditary motor and sensory neuropathy (CMT)
- Neuropathies in childhood
- Idiopathic
Cranial nerve anatomy
I, II –> cerebrum
III, IV –> midbrain
V, VI, VII, VIII –> pons
IX, X, XI, XII –> medulla
Cranial nerves in cavernous sinus
III, IV, VI, first branch of V
Multiple sclerosis exam findings
Inspect- gait aids
CN exam- optic neuritis (fundoscopy- blurring of optic disc, pallor), RAPD, INO, facial palsy, loss of balance/sensorineural deafness, speech/swallowing difficulty
Cerebellar exam- nystagmus, intention tremor, dysarthria
UL + LL- hypertonia, hyperreflexia, decreased power/spasticity, clonus, abnormal sensation
Ix- MRIB + spinal cord with contrast –> T2 hyperintense white matter plaques, CSF, VEP
Causes of INO
Ipsilateral loss of adduction + horizontal nystagmus of contralateral eye
= Lesion of medial longitudinal fasciculus
Causes = MS, brainstem lesion/infarct, head trauma
Causes of wasted hand
Brachial plexus injury
Carpal tunnel syndrome
Peripheral nerve injury
MND- split hand syndrome
Syringomyelia
Congenital- CMT, myotonic dystrophy, inclusion body myositis
Nutritional/disuse
Myotonic dystrophy signs
Face- frontal baldness, triangular facies, temporalis/masseter wasting, partial ptosis, dysarthria
Neck flexion weakness
Grip myotonia
Difficulty opening eyes after closure
Reduced/absent reflexes
Thenar eminence tap
Forearm muscle wasting
Generalised weakness in arms and legs
Peripheral sensory neuropathy
Foot drop
FSH dystrophy signs
Expressionless facies
Muscle weakness in face, shoulders and distal legs (tibialis anterior)
No ophthalmoplegia
Winged scapula, difficulty raising arms
Spared wasting of forearms
Protuberant in lower abdomen- Beevor’s sign
Cortical signs
Speech- aphasia
Focal motor weakness- face/arm (MCA) vs. leg (ACA)
Cortical sensory deficit- stereognosis, 2 point discrimination
Eyes- visuospatial neglect, visual field defect, gaze deviation to affected hemisphere
Higher function- agraphia, apraxia, acalculia
Subcortical signs
Face-arm-legs equally affected
Pure motor- lacunar lesion
Pure sensory- thalamic lesion
Mixed motor and sensory- thalamus and internal capsule
Brainstem lesion
INO/nystagmus
Cranial nerve palsies
Ataxia
Altered consciousness
Contralateral motor deficit- crossed limb signs
Autonomic features
Horner’s syndrome
Ptosis, miosis + anhydrosis
Causes of proximal myopathy
Endocrine- Cushing’s syndrome, hypothyroidism, acromegaly
Inflammatory- polymyositis, dermatomyositis, scleroderma, MCTD
Drugs- statin, alcohol
NMJ- MG, LEMS
Dystrophies- muscular dystrophy
Causes of motor + sensory neuropathy
AIDP/CIDP
Vasculitic neuropathy
Plexus lesion
Ipsilateral
Single limb with LMN signs
Painful
Not attributable to single peripheral nerve/spinal level
Conus medullaris lesion
Bilateral LL UMN weakness
Bowel/bladder dysfunction
